What is the role of botulinum toxin (BTX) injections in the treatment of primary headache disorders?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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In 2004, the International Headache Society (IHS) published the second edition of the International Classification of Headache Disorders (ICHD), which divides headaches into primary and secondary disorders. Primary headache disorders are defined as those which occur as the result of a primary neurological process, whereas secondary headaches are attributed to an identifiable underlying cause or condition of the nervous system. Primary headache disorders include migraine, tension-type headaches and cluster headaches, among others.

Migraine is defined as a headache with at least moderate intensity that is frequently unilateral, throbbing, and usually accompanied by nausea, photophobia and phonophobia. Tension-type headache is characterized as a bandlike tightness without migraine-associated symptoms. In 1994, a revision of the established IHS criteria was proposed using the eponym "chronic daily headache" to describe a condition that occurs 15 or more days per month, with an average untreated duration of more than 4 h/h. [105]

BTX is an appropriate consideration for treatment of refractory headache, especially chronic daily headache, when standard pharmacology is ineffective or fraught by adverse side effects. BTXs are an enticing alternative to many standard preventive medications that interfere with alertness or cognitive efficiency in people who provide complex intellectual services or operate industrial equipment, including aircraft or other vehicular machinery. Therapeutic benefits may occur due to elimination of localized myalgia, muscular triggers, or painful muscle tension that accompany a headache; however, the aforementioned theorized CNS antinociceptive effects may be more salient. [73]

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